Showing posts with label Obstructive Sleep Apnea. Show all posts
Showing posts with label Obstructive Sleep Apnea. Show all posts
Tuesday, September 25, 2007
Too Little Or Too Much Sleep Increases Risk Of Death
Too Little Or Too Much Sleep Increases Risk Of Death
25 Sep 2007
Researchers from the University of Warwick, and University College London, have found that lack of sleep can more than double the risk of death from cardiovascular disease.
However they have also found that a point comes when too much sleep can also more than double the risk of death.
In research presented to the British Sleep Society, Professor Francesco Cappuccio from the University of Warwick's Warwick Medical School showed the results of a study of how sleep patterns affected the mortality of 10,308 civil servants in the "Whitehall II study". Amongst other things the data they used provided information on the mortality rates and sleep patterns on the same group of civil servants at two points in their life (1985-8 and those still alive in 1992-3).
The researchers took into account other possible factors such age, sex, marital status, employment grade, smoking status, physical activity, alcohol consumption, self-rated health, body mass index, blood pressure, cholesterol, other physical illness etc. Once they had adjusted for those factors they were able to isolate the effect that changes in sleep patterns over 5 years had on mortality rates 11-17 years later.
Taking those who had not made any change in their sleeping habits between 1985-8 and 1992-3 as their baseline (7 hours per night being the figure normally recommended as an appropriate period of sleep for an adult) they were able to see what difference having reduced the amount of sleep over time made to mortality rates by 2004.
Those who had cut their sleeping from 7h to 5 hours or less faced a 1.7 fold increased risk in mortality from all causes, and twice the increased risk of death from a cardiovascular problem in particular.
Professor Francesco Cappuccio from the University of Warwick's Warwick Medical School said to the British Sleep Society:
"Fewer hours sleep and greater levels of sleep disturbance have become widespread in industrialised societies. This change, largely the result of sleep curtailment to create more time for leisure and shift-work, has meant that reports of fatigue, tiredness and excessive daytime sleepiness are more common than a few decades ago. Sleep represents the daily process of physiological restitution and recovery, and lack of sleep has far-reaching effects."
Curiously the researchers also found that too much sleep also increased mortality. They found that those individuals who showed an increase in sleep duration to 8 hours or more a night were more than twice as likely to die as those who had not changed their habit, however, predominantly from non-cardiovascular diseases.
Professor Francesco Cappuccio says:
"Short sleep has been shown to be a risk factor for weight gain, hypertension and Type 2 diabetes sometimes leading to mortality but in contrast to the short sleep-mortality association it appears that no potential mechanisms by which long sleep could be associated with increased mortality have yet been investigated. Some candidate causes for this include depression, low socioeconomic status and cancer-related fatigue."
"In terms of prevention, our findings indicate that consistently sleeping around 7 hours per night is optimal for health and a sustained reduction may predispose to ill-health."
The research paper entitled: "A prospective study of change in sleep duration; associations with mortality in the Whitehall II cohort" will be published in the Journal SLEEP and the full list of the authors is: Jane E. Ferrie, Martin J. Shipley, Francesco P. Cappuccio, Eric Brunner, Michelle A. Miller, Meena Kumari, and Michael G. Marmot
Monday, September 17, 2007
A Nasal Cannula Can Be Used to Treat Obstructive Sleep Apnea
A Nasal Cannula Can Be Used to Treat Obstructive Sleep Apnea
American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 194-200, (2007)
Brian M. McGinley1, Susheel P. Patil1, Jason P. Kirkness1, Philip L. Smith1, Alan R. Schwartz1 and Hartmut Schneider1
1 Johns Hopkins Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
Correspondence and requests for reprints should be addressed to Hartmut Schneider, M.D., Ph.D., Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Room 4B47, Baltimore, MD 21224. E-mail: hschneid@jhmi.edu
Rationale: Obstructive sleep apnea syndrome is due to upper airway obstruction and is associated with increased morbidity. Although continuous positive airway pressure efficaciously treats obstructive apneas and hypopneas, treatment is impeded by low adherence rates.
Objectives: To assess the efficacy on obstructive sleep apnea of a minimally intrusive method for delivering warm and humidified air through an open nasal cannula.
Methods: Eleven subjects (age, 49.7 ± 5.0 yr; body mass index, 30.5 ± 4.3 kg/m2), with obstructive apnea–hypopnea syndrome ranging from mild to severe (5 to 60 events/h), were administered warm and humidified air at 20 L/minute through an open nasal cannula.
Measurements and Main Results: Measurements were based on standard sleep-disordered breathing and arousal indices. In a subset of patients pharyngeal pressure and ventilation were assessed to determine the mechanism of action of treatment with nasal insufflation. Treatment with nasal insufflation reduced the mean apnea–hypopnea index from 28 ± 5 to 10 ± 3 events per hour (p < 0.01), and reduced the respiratory arousal index from 18 ± 2 to 8 ± 2 events per hour (p < 0.01). Treatment with nasal insufflation reduced the apnea–hypopnea index to fewer than 10 events per hour in 8 of 11 subjects, and to fewer than 5 events per hour in 4 subjects. The mechanism of action appears to be through an increase in end-expiratory pharyngeal pressure, which alleviated upper airway obstruction and improved ventilation.
Conclusions: Our findings demonstrate clinical proof of concept that a nasal cannula for insufflating high airflows can be used to treat a diverse group of patients with obstructive sleep apnea.
AT A GLANCE COMMENTARY
Scientific Knowledge on the SubjectHigh levels of continuous positive airway pressure (CPAP) are needed to alleviate obstructive apneas; low compliance with CPAP impedes its therapeutic effectiveness; and, because hypopneas can be treated with low levels of CPAP, nasal insufflation of air might effectively treat mild obstructive sleep apnea.
What This Study Adds to the FieldNasal insufflation can provide distinct clinical advantages over CPAP for a substantial proportion of the patient population with sleep apnea.
American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 194-200, (2007)
Brian M. McGinley1, Susheel P. Patil1, Jason P. Kirkness1, Philip L. Smith1, Alan R. Schwartz1 and Hartmut Schneider1
1 Johns Hopkins Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
Correspondence and requests for reprints should be addressed to Hartmut Schneider, M.D., Ph.D., Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Room 4B47, Baltimore, MD 21224. E-mail: hschneid@jhmi.edu
Rationale: Obstructive sleep apnea syndrome is due to upper airway obstruction and is associated with increased morbidity. Although continuous positive airway pressure efficaciously treats obstructive apneas and hypopneas, treatment is impeded by low adherence rates.
Objectives: To assess the efficacy on obstructive sleep apnea of a minimally intrusive method for delivering warm and humidified air through an open nasal cannula.
Methods: Eleven subjects (age, 49.7 ± 5.0 yr; body mass index, 30.5 ± 4.3 kg/m2), with obstructive apnea–hypopnea syndrome ranging from mild to severe (5 to 60 events/h), were administered warm and humidified air at 20 L/minute through an open nasal cannula.
Measurements and Main Results: Measurements were based on standard sleep-disordered breathing and arousal indices. In a subset of patients pharyngeal pressure and ventilation were assessed to determine the mechanism of action of treatment with nasal insufflation. Treatment with nasal insufflation reduced the mean apnea–hypopnea index from 28 ± 5 to 10 ± 3 events per hour (p < 0.01), and reduced the respiratory arousal index from 18 ± 2 to 8 ± 2 events per hour (p < 0.01). Treatment with nasal insufflation reduced the apnea–hypopnea index to fewer than 10 events per hour in 8 of 11 subjects, and to fewer than 5 events per hour in 4 subjects. The mechanism of action appears to be through an increase in end-expiratory pharyngeal pressure, which alleviated upper airway obstruction and improved ventilation.
Conclusions: Our findings demonstrate clinical proof of concept that a nasal cannula for insufflating high airflows can be used to treat a diverse group of patients with obstructive sleep apnea.
AT A GLANCE COMMENTARY
Scientific Knowledge on the SubjectHigh levels of continuous positive airway pressure (CPAP) are needed to alleviate obstructive apneas; low compliance with CPAP impedes its therapeutic effectiveness; and, because hypopneas can be treated with low levels of CPAP, nasal insufflation of air might effectively treat mild obstructive sleep apnea.
What This Study Adds to the FieldNasal insufflation can provide distinct clinical advantages over CPAP for a substantial proportion of the patient population with sleep apnea.
Thursday, August 30, 2007
CPAP Machine May Help Prevent Heart Attack, Stroke in People With Obstructive Sleep Apnea
Sleep Apnea Device May Help Save Heart
CPAP Machine May Help Prevent Heart Attack, Stroke in People With Obstructive Sleep Apnea
By Miranda Hitti WebMD Medical News
Reviewed by Louise Chang, MD
Aug. 29, 2007 -- A device that treats a common sleep disorder called obstructive sleep apnea may help prevent heart attacks, strokes, and other cardiovascular problems, a new study shows.
Obstructive sleep apnea is a very serious condition in which people have trouble breathing during sleep because their airway is blocked. They may have very shallow breath or even stop breathing briefly several times per night.
A device called CPAP (continuous positive airway pressure) helps people with obstructive sleep apnea breathe more easily during sleep.
The new study comes from German doctors including Nikolaus Buchner, MD, of Germany's Ruhr University Bochum.
They already knew that CPAP may reduce heart risks in people with severe obstructive sleep apnea. Buchner's team wanted to see if that's also true for people with milder obstructive sleep apnea.
CPAP Study
Buchner and colleagues offered CPAP machines to 449 adults with mild, moderate, or severe obstructive sleep apnea. All but 85 patients accepted the devices.
The patients, who got regular checkups, were typically followed for about six years.Those who accepted CPAP were 64% less likely to have certain fatal or nonfatal cardiovascular problems -- including heart attacks and strokes -- during the study period, regardless of their age, BMI (body mass index), type 2 diabetes, cholesterol, and history of heart disease.
Buchner and colleagues note that their findings may not apply to everyone with obstructive sleep apnea.
However, the researchers write that therapy for obstructive sleep apnea "should be considered" even for mild forms of obstructive sleep apnea.
The study appears in an advance online edition of the American Journal of Respiratory and Critical Care Medicine.
SOURCES: Buchner, N. American Journal of Respiratory and Critical Care Medicine, Aug. 2, 2007; advance online edition. National Heart, Lung, and Blood Institute: "Sleep Apnea." WebMD Medical News: "Treatment for Sleep Apnea May Ease Depression."
CPAP Machine May Help Prevent Heart Attack, Stroke in People With Obstructive Sleep Apnea
By Miranda Hitti WebMD Medical News
Reviewed by Louise Chang, MD
Aug. 29, 2007 -- A device that treats a common sleep disorder called obstructive sleep apnea may help prevent heart attacks, strokes, and other cardiovascular problems, a new study shows.
Obstructive sleep apnea is a very serious condition in which people have trouble breathing during sleep because their airway is blocked. They may have very shallow breath or even stop breathing briefly several times per night.
A device called CPAP (continuous positive airway pressure) helps people with obstructive sleep apnea breathe more easily during sleep.
The new study comes from German doctors including Nikolaus Buchner, MD, of Germany's Ruhr University Bochum.
They already knew that CPAP may reduce heart risks in people with severe obstructive sleep apnea. Buchner's team wanted to see if that's also true for people with milder obstructive sleep apnea.
CPAP Study
Buchner and colleagues offered CPAP machines to 449 adults with mild, moderate, or severe obstructive sleep apnea. All but 85 patients accepted the devices.
The patients, who got regular checkups, were typically followed for about six years.Those who accepted CPAP were 64% less likely to have certain fatal or nonfatal cardiovascular problems -- including heart attacks and strokes -- during the study period, regardless of their age, BMI (body mass index), type 2 diabetes, cholesterol, and history of heart disease.
Buchner and colleagues note that their findings may not apply to everyone with obstructive sleep apnea.
However, the researchers write that therapy for obstructive sleep apnea "should be considered" even for mild forms of obstructive sleep apnea.
The study appears in an advance online edition of the American Journal of Respiratory and Critical Care Medicine.
SOURCES: Buchner, N. American Journal of Respiratory and Critical Care Medicine, Aug. 2, 2007; advance online edition. National Heart, Lung, and Blood Institute: "Sleep Apnea." WebMD Medical News: "Treatment for Sleep Apnea May Ease Depression."
Wednesday, May 30, 2007
Obstructive Sleep Apnea Wearies the Heart
AAPA: Obstructive Sleep Apnea Wearies the Heart
A lecture delivered at the American Academy of Physician Assistants conference, Philadelphia, Pa., May 26-31.
Review
PHILADELPHIA, May 29 -- The most obvious clinical feature of obstructive sleep apnea may be weariness of mind, but this breathing disorder also slowly and silently wears down the heart, according to researchers.
Recent evidence suggests that 60% of people hospitalized for myocardial infarction also have obstructive sleep apnea. Yet occurrence among the general population is only about 9%, said Jose R. Marquina, M.D., of the Collier County Medical Society in Naples, Fla., at the American Academy of Physician Assistants meeting here.
In addition, recent research also suggests that as many as 70% of patients hospitalized for stroke have obstructive sleep apnea as a comorbid condition, Dr. Marquina said.
During the night, severe sleep apnea sufferers stop breathing anywhere from 30 to 120 times per hour, and the resulting lack of oxygen in the body strains and stupefies the cardiovascular system, Dr. Marquina said.
Over the years, hypoxemia in patients with obstructive sleep apnea can damage the sinus node, the group of specialized heart cells that govern cardiac rhythm, he said. This hypoxic damage causes a variety of cardiac arrhythmias including bradycardia, atrial fibrillation, and sinus arrest.
In addition, he said, the stress of hypoxemia causes the body to release catecholines, a group of hormones linked to hypertension.
Oxygen levels in the blood are also involved in controlling pulmonary artery pressure, Dr. Marquina said, and chronic hypoxemia can, therefore, also lead to pulmonary hypertension. In fact, recent evidence suggests that 12% to 17% of patients with obstructive sleep apnea also have pulmonary hypertension, he said.
These cardiovascular effects of obstructive sleep apnea occur in addition to the more well known neurological effects, which include cerebral anoxia, cerebrovascular disease, and impaired memory and concentration, Dr. Marquina said.
Obstructive sleep apnea can also severely reduce a person's overall quality of life. The condition has been associated with poor performance at work or school, depression, and marital problems, he said.
Men are affected twice as often as women: occurrence is 4% among men versus 2% among women, Dr. Marquina said. The risk for obstructive sleep apnea also increases among those who are overweight. Among overweight men the occurrence rises to 24%, and it reaches 9% for overweight women, he said.
As many as 90% of cases of obstructive sleep apnea go undiagnosed, Dr. Marquina said. Clinicians should be more aware of the symptoms, which include excessive daytime sleepiness or tiredness upon waking. "The typical patient will say they slept for eight hours but woke up still feeling tired," he said.
Another symptom is loud snoring, although snoring also occurs normally in about 70% of individuals age 35 and older, Dr. Marquina said. Patients will often deny snoring, so it may be more useful to ask a bed partner about this condition, he added.
Up to five episodes of apnea per hour while sleeping is also normal for healthy individuals, Dr. Marquina said. But five to 15 episodes identified by polysomnography indicate mild obstructive sleep apnea, 15 to 30 are defined as a moderate condition, and 30 or more are defined as severe obstructive sleep apnea, he said.
In addition, obstructive sleep apnea tends to be associated with a neck circumference of 18 inches or more, he said.
"Obstructive sleep apnea must be treated not only to improve the symptoms of fatigue and overall quality of life but to prevent the development of cardiovascular problems," Dr. Marquina concluded.
Dr. Marquina is a speaker for Cephalon.
Primary source: American Academy of Physician Assistants conference
Source reference:
Marquina J. "The consequences of sleep: snoring, obstructive sleep apnea, and cardiovascular disease." A lecture delivered at the American Academy of Physician Assistants conference, Philadelphia, Pa., May 26-31.
A lecture delivered at the American Academy of Physician Assistants conference, Philadelphia, Pa., May 26-31.
Review
PHILADELPHIA, May 29 -- The most obvious clinical feature of obstructive sleep apnea may be weariness of mind, but this breathing disorder also slowly and silently wears down the heart, according to researchers.
Recent evidence suggests that 60% of people hospitalized for myocardial infarction also have obstructive sleep apnea. Yet occurrence among the general population is only about 9%, said Jose R. Marquina, M.D., of the Collier County Medical Society in Naples, Fla., at the American Academy of Physician Assistants meeting here.
In addition, recent research also suggests that as many as 70% of patients hospitalized for stroke have obstructive sleep apnea as a comorbid condition, Dr. Marquina said.
During the night, severe sleep apnea sufferers stop breathing anywhere from 30 to 120 times per hour, and the resulting lack of oxygen in the body strains and stupefies the cardiovascular system, Dr. Marquina said.
Over the years, hypoxemia in patients with obstructive sleep apnea can damage the sinus node, the group of specialized heart cells that govern cardiac rhythm, he said. This hypoxic damage causes a variety of cardiac arrhythmias including bradycardia, atrial fibrillation, and sinus arrest.
In addition, he said, the stress of hypoxemia causes the body to release catecholines, a group of hormones linked to hypertension.
Oxygen levels in the blood are also involved in controlling pulmonary artery pressure, Dr. Marquina said, and chronic hypoxemia can, therefore, also lead to pulmonary hypertension. In fact, recent evidence suggests that 12% to 17% of patients with obstructive sleep apnea also have pulmonary hypertension, he said.
These cardiovascular effects of obstructive sleep apnea occur in addition to the more well known neurological effects, which include cerebral anoxia, cerebrovascular disease, and impaired memory and concentration, Dr. Marquina said.
Obstructive sleep apnea can also severely reduce a person's overall quality of life. The condition has been associated with poor performance at work or school, depression, and marital problems, he said.
Men are affected twice as often as women: occurrence is 4% among men versus 2% among women, Dr. Marquina said. The risk for obstructive sleep apnea also increases among those who are overweight. Among overweight men the occurrence rises to 24%, and it reaches 9% for overweight women, he said.
As many as 90% of cases of obstructive sleep apnea go undiagnosed, Dr. Marquina said. Clinicians should be more aware of the symptoms, which include excessive daytime sleepiness or tiredness upon waking. "The typical patient will say they slept for eight hours but woke up still feeling tired," he said.
Another symptom is loud snoring, although snoring also occurs normally in about 70% of individuals age 35 and older, Dr. Marquina said. Patients will often deny snoring, so it may be more useful to ask a bed partner about this condition, he added.
Up to five episodes of apnea per hour while sleeping is also normal for healthy individuals, Dr. Marquina said. But five to 15 episodes identified by polysomnography indicate mild obstructive sleep apnea, 15 to 30 are defined as a moderate condition, and 30 or more are defined as severe obstructive sleep apnea, he said.
In addition, obstructive sleep apnea tends to be associated with a neck circumference of 18 inches or more, he said.
"Obstructive sleep apnea must be treated not only to improve the symptoms of fatigue and overall quality of life but to prevent the development of cardiovascular problems," Dr. Marquina concluded.
Dr. Marquina is a speaker for Cephalon.
Primary source: American Academy of Physician Assistants conference
Source reference:
Marquina J. "The consequences of sleep: snoring, obstructive sleep apnea, and cardiovascular disease." A lecture delivered at the American Academy of Physician Assistants conference, Philadelphia, Pa., May 26-31.
Sunday, May 27, 2007
Sleep apnea increases risk of heart attack
Sleep apnea increases risk of heart attack (from Heart Watch)
The nighttime breathing disorder known as obstructive sleep apnea increases a persons risk of having a heart attack or dying by 30% over a period of four to five years, as per a research studypresented at the American Thoracic Society 2007 International Conference, on Monday, May 21.
The more severe the sleep apnea at the beginning of the study, the greater the risk of developing heart disease or dying, the study found.
While prior studies have shown an association between sleep apnea and heart disease, ours is a large study that allowed us to not only follow patients for five years and look at the association between sleep apnea and the combined outcome of heart attack and death, but also adjust for other traditional risk factors for heart disease, says researcher Neomi Shah, M.D., of Yale University.
We recommend that patients who experience symptoms of obstructive sleep apneaexcessive daytime sleepiness, or snoring along with breathing pausesconsult their physician, Dr. Shah says. There is some evidence to make us think that when sleep apnea is appropriately treated, the risk of heart disease can be lowered.
In obstructive sleep apnea, the upper airway narrows, or collapses, during sleep. Periods of apnea end with a brief partial arousal that may disrupt sleep hundreds of times a night. Obesity is a major risk factor for sleep apnea.
The most effective therapy for sleep apnea is a technique called nasal CPAP, for continuous positive airway pressure, which delivers air through a mask while the patient sleeps, keeping the airway open. It has proved successful in a number of cases in providing a good nights sleep, preventing daytime accidents due to sleepiness and improving quality of life.
The study included 1,123 patients referred for sleep apnea evaluation. They underwent an overnight sleep study to determine if they had sleep apnea. Over the next four to five years, they were followed to see how a number of had any heart disease events (heart attack, coronary angiography or bypass surgery) or died.
Sleep apnea triggers the bodys fight or flight mechanism, which decreases the amount of blood pumped to the heart. Repeated episodes every night for a few years can starve the heart of enough oxygen when it is combined with the bodys decreased oxygen intake due to the frequent breathing stoppages during the night, Dr. Shah says.
The nighttime breathing disorder known as obstructive sleep apnea increases a persons risk of having a heart attack or dying by 30% over a period of four to five years, as per a research studypresented at the American Thoracic Society 2007 International Conference, on Monday, May 21.
The more severe the sleep apnea at the beginning of the study, the greater the risk of developing heart disease or dying, the study found.
While prior studies have shown an association between sleep apnea and heart disease, ours is a large study that allowed us to not only follow patients for five years and look at the association between sleep apnea and the combined outcome of heart attack and death, but also adjust for other traditional risk factors for heart disease, says researcher Neomi Shah, M.D., of Yale University.
We recommend that patients who experience symptoms of obstructive sleep apneaexcessive daytime sleepiness, or snoring along with breathing pausesconsult their physician, Dr. Shah says. There is some evidence to make us think that when sleep apnea is appropriately treated, the risk of heart disease can be lowered.
In obstructive sleep apnea, the upper airway narrows, or collapses, during sleep. Periods of apnea end with a brief partial arousal that may disrupt sleep hundreds of times a night. Obesity is a major risk factor for sleep apnea.
The most effective therapy for sleep apnea is a technique called nasal CPAP, for continuous positive airway pressure, which delivers air through a mask while the patient sleeps, keeping the airway open. It has proved successful in a number of cases in providing a good nights sleep, preventing daytime accidents due to sleepiness and improving quality of life.
The study included 1,123 patients referred for sleep apnea evaluation. They underwent an overnight sleep study to determine if they had sleep apnea. Over the next four to five years, they were followed to see how a number of had any heart disease events (heart attack, coronary angiography or bypass surgery) or died.
Sleep apnea triggers the bodys fight or flight mechanism, which decreases the amount of blood pumped to the heart. Repeated episodes every night for a few years can starve the heart of enough oxygen when it is combined with the bodys decreased oxygen intake due to the frequent breathing stoppages during the night, Dr. Shah says.
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